Another “war” on “drugs”?

I have been working in the family service area of the substance abuse field since January 1, 2009. However, my sobriety date is February 23, 2010.

How is this possible?

Through the use of MAT, or Medication Assisted Treatment, I was able to stabilize and manage my life long enough to create new opportunities, and start moving forward in my life once again beyond my crippling addiction.

My first day in my new office at the Cummings Center felt like a dream come true. I had been able to establish a non-profit organization called Renewed Hope Project, which had a clear mission to help families address their concerns regarding a loved one’s addiction.

With my feet up on my desk in my new office, leaned back in my chair, I was ready for a call. I actually felt ready for the first time in a long time. I was about to start what would ultimately become my new way of life in recovery – working with, and helping, families struggling with addiction.

I carried around a small stainless-steel waterproof container attached to my keys. Inside of this container was my medicine, which I carried around with me at all times. Inside were the hexagon shaped orange pills I had come to rely on for my physical and emotional stability. These pills had basically become the foundation upon which I was building my new life and business.

That statement may sound a little crazy, because the idea was kind of crazy. My new way of life was about to be built upon the foundation of a prescription medication.

Previously, as an active opiate addict I would very often find myself trying to live a normal version of life while still actively using heroin. Taking my medicine (Heroin) in the morning to go to work, and then taking multiple doses of my “medicine” throughout the day as needed to maintain. This was the foundation I had spent many years trying to build my life upon without any real lasting success because my “medication” was such an unstable foundation to build on.

This medicinal MAT approach seemed extremely familiar. Familiar in the sense that I was still fighting off the same type of withdrawal with each prescribed dose. The sense that if my doctor “cut me off”, or if I ran out early for any reason, that I would immediately be thrust back into my desperate, survivalist mindset. The addiction was always just behind my medication, and I was afraid to stop for fear of withdrawals as well as the pain of an unmedicated life. I was still just a bad day away from getting high.

I had friends who had done the abstinence-based thing, and the 12-step thing. Friends who had changed their lives for the better, and because of the stigma that existed around MAT within that community, they definitely judged me for being on Suboxone. I could feel it when I brought it up, and I could see the look in people’s eyes when I mentioned that I was sober – but on Suboxone. I didn’t have to share this with anyone who asked, but I did because honesty is supposed to be a part of recovery, right?

When I brought this up to my prescribing physician he assured me that what I was doing was good. He told me that I was making forward progress in my life, and I couldn’t argue with that fact. He then told me that my sobriety was no different than theirs, and that I should be proud of it, but I knew that wasn’t true, I mean how could it be?

How could my life of managed symptoms, be equal to the symptom-free life of my friends in abstinence-based recovery?

I still felt frustrated and trapped because my addiction had to be managed and controlled daily through this “medication” otherwise I was at high risk for relapse. I did not feel well at all on the inside, even though I was no longer using and was actively putting pieces of my life back together. I still felt imprisoned by my fears, and alone in my battle. I still felt like an addict.

This could not possibly be what medicated sobriety had in store for me for the rest of my life, I just couldn’t accept it. I saw freedom in my friends’ eyes when I spoke to them, I saw a sense of peace that just could not be attained through my medications and meetings with my doctor.

I ultimately had to face the reality that even though my life was improving externally through the prescribed use of my medication, and I was no longer causing additional harm in my life, that MAT had done its job and it was time to move on. It was time to seek out a deeper solution beyond what modern medicine had to offer, it was time to get well on the inside.

This would require me breaking free from the psychological and emotional hold that Suboxone and other “medications” had on me. I needed to be set free and given a chance to grow, but of course that path that came with great risks alongside the reward of freedom.

This was not a doctor-approved step in my recovery process. As a matter of fact, it was challenged quite vigorously by my PCP as the worst possible idea for me and for my recovery. My doctor believed that since my symptoms were being successfully managed through medicine, and that I was doing so well in other areas of my life, that coming off of my medication was a bad idea, that it could jeopardize all of my progress and should therefore be re-considered.

I understood his objections but I needed to change something, because even with all the good going on I still felt stuck. That was on me, and it needed to change

Now you may be thinking that I am against Suboxone or MAT in general because of my story so far, or you may just be confused about my position. Let me try to clear things up for you a little.

Suboxone saved my life, and gave me hope. Suboxone is the reason why I am alive and can share my thoughts with you today – but Suboxone is not the solution that helped me get well. It was however, a way to help me arrive at that solution. The medication had done its job. It kept me alive long enough to find a recovery process that could offer me more than a medically managed addiction.

It was hard for me to just accept that medicated life was as good as it would get for me. It made me feel like I was giving up on myself just because the alternative was really hard, and that’s just not who I am or how I’m built.

I fought hard to get off of Suboxone, and it took me multiple attempts and a detox facility to ultimately break free. The detox itself took approximately two full weeks of all-around minor, but extremely frustrating withdrawal symptoms. The normal opiate detox lasts for roughly 3-5 grueling days of severe symptoms, but this was different. Two weeks went by sooooo slow. It was soooo hard to hold on and wait it out.

At times during this process I felt like it would just be so easy to go back to my doctor and tell him I was wrong, that I was ready to get back on the Suboxone, but I fought the temptation because I really wanted this freedom. I was tired of being held hostage by drugs and other medications of any sort, especially if there might be another way. I wasn’t ready to give up on myself or my other options yet.

I can understand why the people around me wanted me to stay on the medicine. From their perspective it was just smarter and safer to keep using it to keep the symptoms at bay, if there was no real “good” reason to stop. The side effects were not obvious to them, just the benefits.

They were unaware of how it made me feel on the inside, and that I was not happy with the emotional quality of life that it provided. I did not like how it felt to still be managed by medication, and that on my best days, I felt like I was not making any real progress to get beyond the physical part of my addiction. I was still stuck.

I imagine that this may be similar to some other mental health issues being managed through various medications. Almost all medications will have some undesired side effects that must be weighed out against the quality of life without the medication. This one was particularly hard for me because I knew people who had found another way without the medication, and were living happily – free from substances.

Was this freedom from all substances really worth the risk? For me, I couldn’t imagine a better version of my life than the one I have today living substance free through the 12-steps of alcoholics anonymous. For me, it was worth the risk. I mean, I had been risking it all every day for years by getting high, running the streets, and going in and out of jail. Playing it safe and staying on medicine even though I felt like it was dampening my emotional quality of life, didn’t make any sense to me.

This is my story and is only meant to share my confusing success story about a couple of wildly debated treatment approaches, and how if used correctly both can be effective. To the best of my knowledge there is no nationally agreed upon 100% successful treatment model for substance use disorder currently being provided in our country. There are just many good (and bad) options for people at various stages of readiness to change.

I have read many articles lately highlighting the great divide within our treatment industry, or the “warring factions” battling it out between CEO’s and medical directors. I have had heated and often disheartening debates in social media forums regarding these different approaches. There seem to be many closed minds on both sides of these debates.

There are those who believe that treating addiction with medicine is this “new thing”, and that the abstinence-based community is living in the past by holding onto archaic treatments that “don’t work anymore”. That this abstinence-based approach is somehow responsible for people dying from Fentanyl and other opiates because it is closed off to the various opiate-based lifesaving medications available that aren’t allowed in their programs.

There are those on the other side (assuming for the moment that there are actually sides) within the abstinence-based community lashing out at the MAT providers. Some of the arguments describe that MAT clinics are just a new version of “pill mills” which are creating a new brand of “office-based addiction” and that they are taking advantage of a vulnerable population of desperate individuals seeking relief.

There have been discussions around the money involved with MAT, and that with all of the federal and local funding going toward science and medicine to treat the overdose epidemic, that people are just chasing the money and not concerning themselves with getting individuals suffering with OUD well any more. There have been suggestions that while MAT is helping to curb opiate overdose death that somehow, it is also treating the addiction simply by preventing death and reducing the cravings.

There is a lot of debate on both “sides”. But there aren’t really sides in this fight, are there? There are not people within the industry arguing that we should let them die. There are not people suggesting that individuals “can’t” use medication, or that they “can’t” try abstinence-based models. There are just a lot of people trying to use whatever they can to respond to a growing epidemic without a clearly defined 100% effective solution.

The opioid epidemic itself has been around for decades and has taken many forms with each new prescription opioid made available to the masses. The overdose epidemic associated with the use of opioids has been developing more rapidly over the past few years, and has just recently evolved into a more visible problem nationally due the introduction of Fentanyl and other stronger opioid-based prescriptions. Treating these two problems as though they are the same thing, might not be the best approach.

I can appreciate the desperation to keep people alive “at all costs”. I mean, if we can’t meet them, we can’t treat them. This is an agreed upon statement throughout the treatment industry, abstinence-based or MAT focused. We can all agree that whatever gets them through the door is a good start. But then what? I think that is where it gets fuzzy.

What does evidence-based treatment offer beyond the medication, the therapy, and the social supports? What is the end-game or goal for a client to measure their progress? Is the ultimate goal abstinence, or managed symptom relief through maintenance doses of medication? What is left for evidence-based modalities when that scientific approach doesn’t work for a person? What’s next for those people?

In that same vein, what happens next after someone tries and is not willing, or capable enough to buy into an abstinence-based, or 12-step spiritual model of recovery? Because they were not “ready” enough to accept this option or put in the work does that mean that they cannot get well through other paths to recovery? Are they lost and hopeless? Is abstinence the only way?

These are some of the questions that keep the argument going on both “sides”.

My experience tells me that there can be success using either, or both of these approaches, but that one model and its supporters should not force out another because they are not aligned.

For instance, a sober living home should have the option to be abstinence-based only (no opioid-based MAT), and others should have the option to provide safe housing for individuals using opioid-based MAT.

Treatment programs that do not use opioid-based MAT should be allowed to provide this option without critical judgement or public persecution, and others should be allowed to provide it as a viable treatment option with the same respect. The choice should be for the client as the consumer, to decide which option suits them best given their desired result.

Saying that there are many paths to treatment and many versions of recovery, while at the same time overtly and/or publicly shunning entire models of treatment, (which I feel happens much too often in the articles I am reading lately and in social media), is not very open minded or helpful.

I have learned over the years as a consumer of these services, and as a professional, that there needs to be a place for both to exist without judgement. They should not conform to each other, but should co-exist as available options that could reinforce each other along the path to recovery. These models and their supporters should try to reinforce one another as professionals working hard to fight the same battle, since we are all just trying to help people find recovery.

Somewhere in the middle there must be a solution. Somewhere there must be a place for those who have had great experiences with both approaches to get together and discuss the facts, not the theories, of both sides. Let’s face it without the “old abstinence-based approach” many of the people pushing or promoting MAT as the only solution wouldn’t be sober today, and if it wasn’t for MAT and its lifesaving abilities, a lot of the abstinence-based programs and providers wouldn’t have as many clients to treat.

Together we can make a difference, divided we will tear ourselves and our clients to pieces.